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HYALOMATRIX

Nebraska rates for HCPCS Q4117

HYALOMATRIX, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $35 · 10th–90th $17$2240%10%10th90th$35Professionalmedian $23 · 10th–90th $23$760%50%10th90th$23$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$22.91
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.44
Typical High
$28.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$18.20
Typical High
$19.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$18.20
Typical High
$19.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$22.91
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$28.84
Typical High
$45.71
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$31.62
Midlands
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$26.30
Typical High
$28.84
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$309.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$19.95
Typical High
$26.30
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$125.89
Typical High
$141.25